Abstract Objective: To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. Methods: A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. Results: The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. Conclusion: In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS.

Abstract Prioritizing corresponds to the process of selecting and managing health needs identified after diagnosing the community's health needs and assets. Recently, the health needs assessment has been reinforced with the community perspective, providing multiple benefits: it sensitizes and empowers the community about their health, encourages mutual support among its members and promotes their importance by making them responsible for the process of improving their own reality. The objective of this paper is to describe the prioritization of Barcelona Salut als Barris, a community health strategy led by the Barcelona Public Health Agency to promote equity in health in the most disadvantaged neighborhoods of the city.

Abstract Clinicians do not have the time or resources to consider the underlying evidence for the myriad decisions they must make each day and, as a consequence, rely on recommendations from clinical practice guidelines. Guideline panels should consider all the relevant factors (criteria) that influence a decision or recommendation in a structured, explicit, and transparent way and provide clinicians with clear and actionable recommendations. In this article, we will describe the Evidence to Decision (EtD) frameworks for clinical practice recommendations. The general structure of the EtD framework for clinical recommendations is similar to EtD frameworks for other types of recommendations and decisions, and includes formulation of the question, an assessment of the different criteria, and conclusions. Clinical recommendations require considering criteria differently, depending on whether an individual patient or a population perspective is taken. For example, from an individual patient's perspective, out-of-pocket costs are an important consideration, whereas, from a population perspective, resource use (not only out-of-pocket costs) and cost effectiveness are important. From a population perspective, equity, acceptability, and feasibility are also important considerations, whereas the importance of these criteria is often limited from an individual patient perspective. Specific subgroups for which different recommendations may be required should be clearly identified and considered in relation to each criterion because judgments might vary across subgroups. This article is a translation of the original article published in the British Medical Journal.The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud.

Abstract Alcohol urban environment has been associated with individual alcohol behaviors. We are constantly exposed to a wide variety of alcohol products, its marketing and promotion and signs of alcohol consumption that may influence alcohol-drinking behaviors. In this photo-essay, we include photographs that visually explain the exposure to alcohol in the urban streetscape of Madrid. These photographs show the pervasiveness of alcohol products in this city, which can be found everywhere at any time.

Abstract The interests of the food industry to fund nutrition and health research are not limited to promoting scientific advances. Recently, several systematic reviews conducted about the effect of sugar-sweetened beverages and health outcomes have shown some biased conclusions in studies that acknowledge industry sponsorship. In this context, the Nutrition Working Group of the Spanish Epidemiology Society presented a scientific session entitled Food industry and epidemiologic research at its annual meeting. In a round table, four experts in nutrition research presented their points of view about whether the food industry should fund nutrition-related research and the related potential conflicts of interest of the food industry. All the experts agreed not only on defending independence in nutritional epidemiology regarding the design, interpretation and conclusion of their studies but also on the crucial need for guaranteed scientific rigor, scientific quality of the results and measures to protect studies against potential biases related to the conflicts of interest of funding by the food industry. Drs Pérez-Farinós and Romaguera believe that the most effective way to prevent conflicts of interest would be not to allow the food industry to fund nutrition research; Drs Marcos and Martínez-González suggested the need to establish mechanisms and strategies to prevent the potential influences of the food industry in selecting researchers or institutional sponsorship and in the analysis and results of the studies, to ensure maximum independence for researchers, as well as their professional ethics.

Abstract Objective: To design and validate a specific instrument to detect exercised and suffered in the relations of young couples in violence. Method: Descriptive study of validation clinimetric. Stratified by sex and area of knowledge, which was adopted as inclusion criteria have or have had any relationship. The sample consisted of 447 subjects. Results: We obtained the Multidimensional Scale Dating Violence (EMVN), 32 items with three dimensions: physical and sexual assault, behavior control (cyberbullying, surveillance and harassment) and abuse psicoemocional (disparagement and domination), as a victim or as aggressor. No statistically significant differences were found between the violence exerted and the violence suffered, but it was based on sex. Conclusion: The EMVN is a valid and reliable scale that measures the different elements of violence in couples of young people and you can suppose a resource for the comprehensive detection of violent behaviors in dating relationships that are established among young people.

Abstract Clinicians, guideline developers, and policymakers sometimes neglect important criteria, give undue weight to criteria, and do not use the best available evidence to inform their judgments. Explicit and transparent systems for decision making can help to ensure that all important criteria are considered and that decisions are informed by the best available research evidence. The GRADE Working Group has developed Evidence to Decision (EtD) frameworks for the different type of recommendations or decisions. The purpose of EtD frameworks is to help people use evidence in a structured and transparent way to inform decisions in the context of clinical recommendations, coverage decisions, and health system or public health recommendations and decisions. EtD frameworks have a common structure that includes formulation of the question, an assessment of the evidence, and drawing conclusions, though there are some differences between frameworks for each type of decision. EtD frameworks inform users about the judgments that were made and the evidence supporting those judgments by making the basis for decisions transparent to target audiences. EtD frameworks also facilitate dissemination of recommendations and enable decision makers in other jurisdictions to adopt recommendations or decisions, or adapt them to their context. This article is a translation of the original article published inBritish Medical Journal. The EtD frameworks are currently used in the Clinical Practice Guideline Programme of the Spanish National Health System, co-ordinated by GuíaSalud.

Abstract Objective: To calculate and analyse the contributions of changes in mortality by age groups and selected causes of death to sex differences in life expectancy at birth in Spain from 1980 to 2012. Methods: Cross-sectional study with three time points (1980, 1995, and 2012). We used data from Human Cause-of-Death Database and Human Mortality Database. We use a decomposition method of the differences in life expectancy and gender differences in life expectancy from changes in mortality by 5-year age groups and causes of death between women and men. Results: From 1980 to 1995, the lower mortality of women from 25 years old, and the differences in mortality by HIV/AIDS, lung cancer, and chronic obstructive pulmonary diseases contributed to the gap increase. From 1995 to 2012, greatest improvement in mortality of males under 74 years of age, and in improving male mortality from HIV/AIDS, acute myocardial infarction and traffic accidents contributed to the narrowing. Conclusions: The difference in life expectancy at birth between men and women has decreased since 1995 due to a greater improvement in mortality from causes of death associated with risky behaviours and habits of the working age male population.

Abstract Objective: To assess the association between long sleep duration and periodontal disease among men and women using nationally representative data. Methods: In this study, we performed a cross-sectional analysis and used multivariable logistic regression analysis models. We analysed data from 2012 through 2014 from the Korean National Health and Nutrition Examination Survey. The analysis in this study was confined to a total of 14,675 respondents over 19 years of age. We used a community periodontal index code greater than or equal to 3 to define periodontitis. Results: The tendency of periodontitis increased with longer sleep duration in women. Compared with women who slept 5hours or less, women with a sleep duration of 6 to 8hours and 9hours or more had higher odds of periodontitis at 1.29 (95% confidence interval [95%CI]: 1.06-1.56) and 1.45 (95%CI: 1.07-1.96), respectively, after adjustment for age, smoking, drinking, exercise, frequency of tooth brushing, self-reported oral status, body mass index, diabetes mellitus, hypertension, white blood cell count, income, and education. A significant relationship between sleep duration and periodontitis was not found in men. Conclusion: Our findings suggest that long sleep duration was associated with periodontitis, after adjusting for potential confounding factors, among Korean women, especially in premenopausal women.